@article{2cf3871f7bec49f39e668191262272b5,
title = "ASSOCIATION OF ANDROGENIC-ANABOLIC STEROID THERAPY WITH DEVELOPMENT OF HEPATOCELLULAR CARCINOMA",
abstract = "Four patients with aplastic an{\ae}mia developed hepatocellular carcinoma after long-term therapy with androgenic-anabolic steroids. In one child there was clinical evidence of tumour regression when the androgen was stopped. There are now epidemiological, clinical, and experimental observations which suggest that an androgenic environment favours development of hepatocellular carcinoma. With the widespread clinical application of androgenic-anabolic steroids (especially their use by athletes) further study to elucidate the precise relationship between this class of drugs and hepatocellular carcinoma is urged.",
author = "Johnson, {F. Leonard} and Lerner, {Kenneth G.} and Marilyn Siegel and Feagler, {John R.} and Majerus, {Philip W.} and Hartmann, {John R.} and Thomas, {E. Donnall}",
note = "Funding Information: methyltestosterone may not previously have been recognised because the specific effect of these agents may be both dose and time related, and most patients do not receive sufficient exogenous androgen for the neoplasm to develop. The definite clinical regression of the hepatic lesion which followed withdrawal of oxymetholone in the first case reported also suggests hormone dependence of these lesions. Since hepatocellular carcinoma in children is usually fatal within 6 months of diagnosis 8 two other possibilities must be considered-namely, the extremely rare spontaneous regression of hepato- cellular carcinoma,23 and that these tumours are not hepatocellular carcinomas but specific histopathological changes induced by oxymetholone which present as a non-malignant hepatic lesion with precisely the same histopathological characteristics as that of hepato-cellular carcinoma. This has important therapeutic implications, for if this is not actually a malignant process then patients who exhibit this change while on androgen therapy may be spared unnecessary surgery, radiation, and chemotherapy. Perhaps all that is necessary is for the androgen to be discontinued. In view of these clinical observations suggesting a relationship between the development of hepatocellular carcinoma and long-term therapy with androgenic- anabolic steroids further studies are necessary to determine the hepatotoxicity of these agents, especially since the efficacy of androgenic-anabolic steroids in severe aplastic anaemia is now questioned 22 and since these drugs are used by athletes, in high dose for significant periods of time, in an attempt to improve their muscular development.24 Supported in part by grants R10 CA10382-07 and 10550 from U.S. National Institute of Health, American Cancer Society grant PRA 33, and grant CA10894 from the U.S. Public Health Service. F. L. J. is supported in part by the New South Wales State Cancer Council and the Postgraduate Committee in Medicine, University of Sydney, Australia. E. D. T. is the recipient of research career award 5 K6A102425 from the U.S. Public Health Service. We thank Dr. R. W. Miller, Dr. R. L. Chard, Jr., Dr. D. Moses, and Mrs. K. Tscheu for their assistance in the preparation of this paper. Requests for reprints should be addressed to F. L. J., Depart-ment of Hematology and Oncology, Children{\textquoteright}s Orthopedic Hospital and Medical Center, 4800 Sand Point Way, N.E., Seattle Washinotnn 98105 U.S.A",
year = "1972",
month = dec,
day = "16",
doi = "10.1016/S0140-6736(72)92649-9",
language = "English",
volume = "300",
pages = "1273--1276",
journal = "The Lancet",
issn = "0140-6736",
number = "7790",
}